United States District Court, W.D. Michigan, Southern Division
L. MALONEY UNITED STATES DISTRICT JUDGE.
action arises under the Employees Retirement Income Security
Act (“ERISA”), 29 U.S.C. § 1132(a)(1)(B).
Before the Court is Plaintiff Andrea Irwin's motion to
reverse Defendant's long-term disability benefits denial
and motion for summary judgment. (ECF No. 11.) Upon careful
review of the record, the Court has decided that the motion
can be resolved without oral argument. See W.D.
Mich. LCivR 7.3(d). For the reasons that follow,
Plaintiff's motion is denied.
worked as a production team member for Gentex Corporation
(“Gentex”), and sought short-term and long-term
disability benefits under a policy issued by United of Omaha
Life Insurance Company (“United”) to Gentex.
Plaintiff was an insured employee covered by this policy.
Under the policy, United would pay insured persons short-term
and long-term disability benefits to which they are entitled,
subject to the terms, conditions, and limitations of the
policy. (Policy, ECF No. 7-2, PageID.212.) It provides:
Disability and disabled mean that because
of an Injury or Sickness, a significant change in Your mental
or physical functional capacity has occurred, as a result of
a) during the Elimination Period, You are prevented from
performing at least one of the Material Duties of Your
Regular Job (on a part-time or full-time basis); and
b) after the Elimination Period, You are:
1. prevented from performing at least one of the Material
Duties of Your Regular Job (on a part-time or full-time
2. unable to generate Current Earnings which exceed 99% of
Your Basic Weekly Earnings due to that same Injury or
Disability is determined relative to Your ability or
inability to work. It is not determined by the availability
of a suitable position with the Policyholder. [ ]
Elimination Period means the number of days of
continuous Disability which must be satisfied before You are
eligible to receive benefits. The elimination period is shown
in the Schedule. [ ]
Material Duties means the essential tasks,
functions, and operations relating to Your Regular Job that
cannot be reasonably omitted or modified. [ ]
Regular Job means the occupation You are routinely
performing when Your Disability begins.
(Id. at PageID.55-58; PageID.240-42.) Under the
long-term policy, “[a]fter a Monthly Benefit has been
paid for 3 years, Disability and Disabled
mean You are unable to perform all of the Material Duties of
any Gainful Occupation.” (Id. at PageID.55.)
Also, instead of regular job, the long-term policy
refers to regular occupation, which is defined as:
the occupation You are routinely performing when Your
Disability begins. Your regular occupation is not limited to
Your specific position held with the Policyholder, but will
instead be considered to be a similar position or activity
based on job descriptions included in the most current
edition of the U.S. Department of Labor Direction of
Occupational Titles. We will have the right to substitute or
replace the DOT with another service or other information
that We determine to be of comparable purpose, with or
without notice. To determine Your regular occupation, We will
look at Your occupation as it is normally performed in the
national economy, instead of how work tasks are performed for
a specific employer, at a specific location, or in a specific
area or region.
(ECF No. 7-1, PageID.58.)
September 5, 2014, Plaintiff presented to David J. Barney, a
certified physician's assistant, for a follow-up visit
for depression and complaints of depressed mood and fatigue,
which began approximately 10 years prior and had gradually
improved since then. (Id. at PageID.107.) On
February 13, 2015, Plaintiff presented to Barney with
insomnia that had worsened since her last visit.
(Id. at PageID.141.) Approximately two months later,
Plaintiff saw Barney and complained of headaches for 3 days.
(Id. at PageID.151.) On June 5, 2015, Plaintiff
presented to Barney with fatigue, described as true arthritis
and true exercise intolerance; her symptoms included
insomnia, depression, and lack of interest in normal
activities. (Id. at PageID.156.) Three weeks later,
Plaintiff saw Barney for a follow-up appointment; she
complained of anhedonia, depressed mood, insomnia, and loss
of energy. (Id. at PageID.163.) On July 22, 2015,
Plaintiff presented to Barney with pain in arms, knees, hips,
bilateral elbows and wrists, described as aching and dull.
Her symptoms included morning stiffness and weakness of hands